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NPI Code Detail

MEDICARE: DR. SOFIA MANI DAVIES DO, MS

MEDICARE: DR. SOFIA MANI DAVIES DO, MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianDR.0062933CO

General Provider Information

NPI Number : 1679078059
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOFIA MANI DAVIES DO, MS
Provider Business Mailing Address
First Line : PO BOX 9049
Second Line :
City : BOULDER
State : CO
Zip : 80301-9049
Country : US
Telephone Number : 303-415-8900
Fax Number :
Provider Business Practice Location Address
First Line : 1645 BROADWAY
Second Line :
City : BOULDER
State : CO
Zip : 80302-6218
Country : US
Telephone Number : 303-415-8900
Fax Number : 303-443-6476
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 09/29/2022

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